Thinking About Gender and Wait Times

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This summer saw the release of the Final Report of the Federal Advisor on Wait Times, the first major document investigating an issue that has generated increasing anxiety in Canada over recent years. Although gender-based analysis (GBA) did not fall within Federal Advisor Dr. Brian Postl’s mandate, the Report acknowledges the pressing need to apply GBA in health care reform research to ensure that appropriate high quality care is available to all men and women, boys and girls. The report supports this call with a recommendation that ongoing wait times research adopt a broad approach to GBA.

By way of beginning this process, a partnership was struck between Women and Health Care Reform (WHCR) and Dr. Postl, as a result of which WHCR authored a paper exploring how gender analysis can contribute to the discussion of wait time management. This paper is included in the appendix of the Final Report.

In Gender-based Analysis and Wait Times: New Questions, New Knowledge, WHCR authors Jackson et al point out that women and men have different experiences of health, illness and treatment, have different health care needs, access health care differently and may experience different outcomes from programs and services. An examination of the available literature on wait times for hip and knee replacements (total joint arthroplasty or TJA), for example, suggests that there are gender differences in the need for this surgery as well as in who is more likely to be on the waiting lists for it. More specifically, available evidence indicates that women have twice the rate of osteoarthritis as men, fewer resources to deal with the impact of the disease than women living with other chronic conditions, and more arthritis pain than men. Women are also more likely than men to be disabled as a result of arthritis, and are more likely than men to require personal assistance with daily activities – but less likely to report unpaid help (in part because elderly women are more likely to live alone). Present definitions of wait times and the constitution of wait lists for TJA obscure these and other differences in men’s and women’s ‘patient journeys’ through the health care system.

The case study of hip and knee replacements demonstrates that GBA is better science - it produces more valid and reliable evidence about wait times - and the evidence produced by GBA can lead to better recommendations, better strategic interventions, and better outcomes for individuals, households, communities and economies.

WHCR continues to apply GBA to the issue of wait times and timely access to health care. In January 2007 WHCR will present the findings and recommendations from New Questions, New Knowledge at a Health Canada policy forum in Ottawa, to demonstrate for policy makers the application of GBA to wait times. Early in 2007 WHCR will release Women and Wait Times, a plain language guide that explains how wait times are a women’s issue, and what the issues are for women.

Women and Health Care Reform [formerly known as the National Coordinating Group on Health Care Reform and Women] is a collaborative group made up of the Centres of Excellence for Women's Health (CEWH) and the Canadian Women's Health Network. Our mandate is to coordinate research on health care reform and to translate this research into policies and practices. Women and Health Care Reform receives support from the Women’s Health Contribution Program, Health Canada. The views herein do not necessarily represent the views of Health Canada.

Gender-based Analysis and Wait Times: New Questions, New Knowledge (2006) by Beth Jackson, Ann Pederson and Madeline Boscoe can be found online at the WHCR website: http://www.womenandhealthcarereform.ca/publications/genderwaittimesen.pdf and at http://www.womenandhealthcarereform.ca, where other examples of the work of the group can be found.

The full Final Report of the Federal Advisor on Wait Times can be found on the Health Canada website, at: http://hc-sc.gc.ca/hcs-sss/pubs/care-soins/2006-wait-attente/index_e.html


WHCR Recommendations on equitable wait times research and policy

  • Gender and diversity analysis should guide wait time management strategies and associated research, policies, programs and services.
  • The definition of ‘wait time' should be sensitive to women's and men's different ‘patient journeys' through the health care system – specifically, the definition should be sensitive to the mechanisms that create delay at every point in the journey, including gender disparities in referral patterns for procedures.
  • Data in wait time reports should be sex disaggregated, as well as disaggregated by other important markers of social location (e.g. race/ethnicity, age, socioeconomic status or income, disability, geographic location).
  • “Historical utilization patterns” should NOT be used to estimate current need for TJA, as they underestimate women's need for the surgery. Historical utilization patterns should be used with caution to estimate need in other clinical areas.
  • Clinicians and wait list coordinators should receive training in gender analysis. Gender-sensitive diagnostic and referral tools should be developed and implemented to more equitably assess men's and women's symptoms and needs (both pre- and post-intervention).
  • Equitable construction and management of wait lists must take into account the supports that men and women require post-intervention, as a lack of support may affect both patients' and clinicians' willingness to consider treatment.